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Zanelli M, Bisagni A, Sanguedolce F, Broggi G, Fragliasso V, Zizzo M, Palicelli A, Martino G, Cresta C, Caprera C, Corsi M, Gentile P, Gozzi F, Trombetta D, Parente P, Caltabiano R, Koufopoulos N, Cimino L, Cavazza A, Fraternali Orcioni G, Ascani S. Co-occurrence of JAK2-V617 F mutation and BCR::ABL1 translocation in chronic myeloproliferative neoplasms: a potentially confounding genetic combination. Front Oncol 2024; 13:1329298. [PMID: 38282677 PMCID: PMC10811046 DOI: 10.3389/fonc.2023.1329298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
Myeloproliferative neoplasms (MPNs) are classified into Philadelphia (Ph) chromosome-positive chronic myeloid leukemia (CML) and Ph-negative MPNs. BCR::ABL1 translocation is the key genetic event of CML, whereas JAK2/MPL/CALR mutations are molecular aberrations of Ph-negative MPNs. Despite initially considered mutually exclusive genetic aberrations, the co-occurrence of BCR::ABL1 and JAK2 has been reported in a limited number of cases. The two genetic alterations may be identified either at the same time or JAK2 aberration may be detected in patients with a previous CML treated with tyrosine kinase inhibitors or, finally, BCR::ABL1 translocation occurs in patients with a history of JAK2-positive MPN. This combination of genomic alterations is potentially confounding with clinical manifestations often misinterpreted either as disease progression or drug resistance, therefore leading to inappropriate patient's treatment. Our systematic review aims to improve hematologist and pathologist knowledge on this rare subset of patients. Starting from the presentation of two additional cases from our routine daily practice, we focus mainly on clinical, laboratory, and bone marrow histological findings, which may represent useful clues of BCR::ABL1 and JAK2 co-occurrence. The interaction between JAK2 and BCR::ABL1 clones during the disease course as well as therapy and outcome are presented.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alessandra Bisagni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, Catania, Italy
| | - Valentina Fragliasso
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emila, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
- Hematology, Centro di Ricerca Emato-Oncologica (C.R.E.O.), University of Perugia, Perugia, Italy
| | - Camilla Cresta
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Cecilia Caprera
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Matteo Corsi
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
| | - Pietro Gentile
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Domenico Trombetta
- Laboratory Oncology, Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | - Paola Parente
- Laboratory Oncology, Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo, San Giovanni Rotondo, Italy
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, Catania, Italy
| | - Nektarios Koufopoulos
- Second Department of Pathology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, Terni, Italy
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Aktekin EH, Yazici N, Kozanoğlu İ, Erbay A. Is very high platelet count always associated with essential thrombocythemia? An unusual presentation in a child. Lab Med 2023; 54:e170-e176. [PMID: 37352366 DOI: 10.1093/labmed/lmad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
Myeloproliferative neoplasms are rare in childhood. They are categorized as Philadelphia chromosome-positive and Philadelphia chromosome-negative. Chronic myeloid leukemia (CML) is the most common myeloproliferative disease in which the Philadelphia chromosome is detected as a result of BCR-ABL rearrangements. In others, the most common genetic abnormality is JAK2V617F mutation. The coexistence of these 2 abnormalities in CML is unexpected, and rare cases have recently been reported in adults. We present a child who had a very high platelet count in which we found this coexistence. The clinical presentation, laboratory findings, management, and prognosis of this coexistence is challenging in such a rare condition.
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Affiliation(s)
- Elif Habibe Aktekin
- Department of Pediatrics Division of Pediatric Hematology-Oncology, Baskent University, Adana, Turkey
| | - Nalan Yazici
- Department of Pediatrics Division of Pediatric Hematology-Oncology, Baskent University, Adana, Turkey
| | - İlknur Kozanoğlu
- Department of Physiology and the Apheresis Unit Adult Bone Marrow Transplant Centre, Baskent University, Adana, Turkey
| | - Ayşe Erbay
- Department of Pediatrics Division of Pediatric Hematology-Oncology, Baskent University, Adana, Turkey
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3
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Zhang Y, Bi H, Wang Y, Chen L, Pan J, Xu P, Wang W, Yang S. BCR-ABL1 is a secondary event after JAK2V617F in a patient with essential thrombocythemia who develop chronic myeloid leukemia. BLOOD SCIENCE 2022; 4:199-204. [PMID: 36518237 PMCID: PMC9742103 DOI: 10.1097/bs9.0000000000000129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/13/2022] [Indexed: 06/17/2023] Open
Abstract
Several cases such as myeloproliferative neoplasms (MPN) with the coexistence of JAK2 and BCR-ABL have been reported. However, cases of transformation of essential thrombocythemia (ET) into chronic myeloid leukemia (CML) during the disease progression were rarely reported. Here, we report the case of a patient with JAK2 V617F- positive ET who subsequently acquired BCR-ABL1, which transformed the disease into CML after 10 years from the initial diagnosis. In this study, we dynamically monitored JAK2 V617F and BCR-ABL and observed multiple gene mutations, including IDH2, IDH1, ASXL1, KRAS, and RUNX1. It is important to be aware of this potentially clone evolution in disease progression.
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Affiliation(s)
- Yanqing Zhang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Hailiang Bi
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Ying Wang
- The Seventh Affiliated Hospital, Sun Yat-sen of University, Shenzhen, Guangdong, P. R. China
| | - Long Chen
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Jiaqi Pan
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Ping Xu
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Wei Wang
- Department of Hematology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, P. R. China
| | - Shaobin Yang
- Department of Molecular Biology Laboratory, Tianjin SINO-US-Diagnostics Co. Ltd, Tianjin, P. R. China
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4
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Secondary chronic myeloid leukemia in a patient with CALR and ASXL1-mutated primary myelofibrosis. Int J Hematol 2022; 116:442-445. [DOI: 10.1007/s12185-022-03331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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5
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Frikha R, Turki F, Kassar O, Elloumi M, Kamoun H. Co-existence of BCR-ABL and JAK2V617F mutation in resistant chronic myeloid leukemia in the imatinib era: Is there a correlation? J Oncol Pharm Pract 2021; 27:1784-1789. [PMID: 33567976 DOI: 10.1177/1078155221991646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Diagnoses of myeloproliferative disorder is based on molecular marker. Chronic Myeloid Leukemia and Myeloproliferative neoplasms were considered mutually exclusive and co-existence of BCR/ABL1 and JAK2 mutation is a rare phenomenon. CASE REPORT Here, we present two cases of co-existence of BCR-ABL and JAK2V617F positivity. We characterize the course of the disease, mainly the minimal residual disease.Management and outcome: The two cases was initially managed as Chronic Myeloid Leukemia and treated by TKI inhibitors. The first one was diagnosed in 2010. He started the first line of TKI, and then switched to second line without obtaining a major molecular response. Hence he was tested for JAK2V617F mutation and positivity was diagnosed. The second patient showed Chronic Myeloid Leukemia phenotype with coexistence of BCR/ABL1 and JAK2 mutation at diagnosis. Molecular monitoring reveals a high BCR-ABL1 transcript level (20%) at the last follow-up (12 months). DISCUSSION Ours results highlight that JAK2V617F/BCR-ABL double positivity may be a potential marker of resistance in Chronic Myeloid Leukemia and clonal molecular analysis is mandatory to elucidate the mechanism. Moreover, the combination of JAK and TKI inhibitors might be effective and potentially be guided by molecular monitoring of minimal residual disease.
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Affiliation(s)
- Rim Frikha
- Department of Medical Genetics, University Hospital of Sfax, Sfax, Tunisia
| | - Fatma Turki
- Department of Medical Genetics, University Hospital of Sfax, Sfax, Tunisia
| | - Olfa Kassar
- Department of Haematology, University Hospital of Sfax, Sfax, Tunisia
| | - Moez Elloumi
- Department of Haematology, University Hospital of Sfax, Sfax, Tunisia
| | - Hassen Kamoun
- Department of Medical Genetics, University Hospital of Sfax, Sfax, Tunisia
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Bader G, Dreiling B. Concurrent JAK2-Positive Myeloproliferative Disorder and Chronic Myelogenous Leukemia: A Novel Entity? A Case Report With Review of the Literature. J Investig Med High Impact Case Rep 2020; 7:2324709619832322. [PMID: 30803277 PMCID: PMC6393948 DOI: 10.1177/2324709619832322] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
JAK2 V617F mutation and BCR-ABL translocation have been considered to be mutually exclusive. However, many cases where both hits coexisted have been reported. We have personally managed a case too. We believe this hybrid entity is underdiagnosed. Thus, we decided to shed light on this "double hit" disease to improve its diagnosis and optimize its treatment. We reviewed the English literature in PubMed since JAK2 discovery. We found 33 cases reported so far. We summarized patient characteristics and analyzed possible interactions between JAK2 and BCR-ABL clones.
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Affiliation(s)
- Gilbert Bader
- 1 University of Mississippi Medical Center, Jackson, MS, USA
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7
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Lorenzo M, Grille S, Stevenazzi M. Emergence of BCR-ABL1 Chronic Myeloid Leukemia in a JAK2-V617F Polycythemia Vera. J Hematol 2020; 9:23-29. [PMID: 32362982 PMCID: PMC7188376 DOI: 10.14740/jh591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/27/2020] [Indexed: 12/15/2022] Open
Abstract
Emergence of a new chronic myeloid neoplasm in the setting of a previous one, or their concomitant appearance seems to be a rare event, but plenty of cases have been reported. We describe the case of a patient with JAK2-V617F polycythemia vera, which looses JAK2 clone and develops overt BCR-ABL1 chronic myeloid leukemia after 6 years. Once treatment with tyrosine kinase inhibitors controls BCR-ABL1 clone, JAK2 clone arises again. In this report, we review the literature and discuss the clonal relationship of this event in light of the new molecular data.
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Affiliation(s)
- Mariana Lorenzo
- Catedra de Hematologia, Hospital de Clinicas, Montevideo 11300, Uruguay
| | - Sofia Grille
- Catedra de Hematologia, Hospital de Clinicas, Montevideo 11300, Uruguay.,Departamento Basico de Medicina, Hospital de Clinicas, Montevideo 11300, Uruguay
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Abstract
PURPOSE OF REVIEW In this review, we emphasize up-to-date practical cytogenetic and molecular aspects of chronic myeloid leukemia (CML) and summarize current knowledge on tyrosine kinase inhibitor (TKI) resistance and treatment response monitoring of CML. RECENT FINDINGS The introduction of TKIs has changed the natural course of CML and markedly improved patient survival. Over the past decades, many research efforts were devoted to elucidating the leukemogenic mechanisms of BCR-ABL1 and developing novel TKIs. More recent studies have attempted to answer new questions that have emerged in the TKI era, such as the cytogenetic and molecular bases of treatment failure and disease progression, the clinical impact of genetic aberrations in Philadelphia chromosome (Ph)-positive and Ph-negative cells, and the biological significance of Ph secondarily acquired during therapy of other hematological neoplasms. Recent progresses in the understanding of the cytogenetic and molecular mechanisms underlying therapeutic failure and disease progression have improved the risk stratification of CML and will be helpful in the design of novel therapeutic strategies.
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Affiliation(s)
- Ting Zhou
- Department of Pathology & Immunology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0072, Houston, TX, 77030, USA
| | - Shimin Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0072, Houston, TX, 77030, USA.
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9
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Hassankrishnamurthy S, Mody MD, Kota VK. A Case of Chronic Myelogenous Leukemia Occurring in a Patient Treated for Essential Thrombocythemia. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:10-14. [PMID: 30602717 PMCID: PMC6325661 DOI: 10.12659/ajcr.911854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient: Female, 49 Final Diagnosis: Essential thrombocythemia with CML Symptoms: Decreased appetite • fatigue • weight loss Medication: — Clinical Procedure: — Specialty: Hematology
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Affiliation(s)
| | - Mayur D Mody
- Department of Internal Medicine, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA.,Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Vamsi K Kota
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
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10
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Yang LH, Su P, Luedke C, Lu CM, Louissaint A, McCall CM, Rapisardo S, Vallangeon B, Wang E. Chronic Myeloid Leukemia Following Treatment for Primary Neoplasms or Other Medical Conditions. Am J Clin Pathol 2018; 150:246-258. [PMID: 29992292 DOI: 10.1093/ajcp/aqy050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Therapy-related chronic myeloid leukemia (CML) has been reported, but its clinical presentation and pathologic features have not yet been well characterized. METHODS Twenty-one cases of CML following treatment for primary diseases were collected and retrospectively analyzed. RESULTS The clinical presentation, pathologic features, and cytogenetic profile were similar to de novo CML. In particular, those with an isolated Philadelphia chromosome constituted 88.9% of our cases, and additional aberrations characteristic of therapy-related acute myeloid leukemia/myelodysplastic syndrome (AML/MDS) were not identified in this study. The patients responded to imatinib/derivatives and survived with limited follow-up. CONCLUSIONS Therapy-related CML has a clinical presentation, pathologic features, and cytogenetic profile akin to de novo CML. Absence of additional significant aberrations seems to suggest a pathogenesis different from therapy-related AML/MDS. Therapy-related CML exhibits a robust therapeutic response to imatinib/derivatives and favorable clinical outcomes similar to de novo CML.
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Affiliation(s)
- Lian-He Yang
- Department of Pathology, First Affiliated Hospital and College of Basic Sciences of China Medical University, Shenyang, China
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Pu Su
- Department of Pathology, Duke University Medical Center, Durham, NC
- Department of Medicine, East Hospital Affiliated to Tongji University School of Medicine, Shanghai, China
| | - Catherine Luedke
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Chuanyi Mark Lu
- Department of Laboratory Medicine, University of California San Francisco
| | - Abner Louissaint
- Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Chad M McCall
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Sarah Rapisardo
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Bethany Vallangeon
- Department of Pathology, East Carolina University Medical Center, Greenville, NC
| | - Endi Wang
- Department of Pathology, Duke University Medical Center, Durham, NC
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11
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Myeloproliferative neoplasms with concurrent BCR-ABL1 translocation and JAK2 V617F mutation: a multi-institutional study from the bone marrow pathology group. Mod Pathol 2018; 31:690-704. [PMID: 29327708 PMCID: PMC6008160 DOI: 10.1038/modpathol.2017.182] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/22/2017] [Accepted: 10/26/2017] [Indexed: 11/08/2022]
Abstract
Myeloproliferative neoplasms arise from hematopoietic stem cells with somatically altered tyrosine kinase signaling. Classification of myeloproliferative neoplasms is based on hematologic, histopathologic and molecular characteristics including the presence of the BCR-ABL1 and JAK2 V617F. Although thought to be mutually exclusive, a number of cases with co-occurring BCR-ABL1 and JAK2 V617F have been identified. To characterize the clinicopathologic features of myeloproliferative neoplasms with concomitant BCR-ABL1 and JAK2 V617F, and define the frequency of co-occurrence, we conducted a retrospective multi-institutional study. Cases were identified using a search of electronic databases over a decade at six major institutions. Of 1570 patients who were tested for both BCR-ABL1 and JAK2 V617F, six were positive for both. An additional five patients were identified via clinical records providing a total of 11 cases for detailed evaluation. For each case, clinical variables, hematologic and genetic data, and bone marrow histomorphologic features were analyzed. The sequence of identification of the genetic abnormalities varied: five patients were initially diagnosed with a JAK2 V617F+ myeloproliferative neoplasm, one patient initially had BCR-ABL1+ chronic myeloid leukemia, while both alterations were identified simultaneously in five patients. Classification of the BCR-ABL1-negative myeloproliferative neoplasms varied, and in some cases, features only became apparent following tyrosine kinase inhibitor therapy. Seven of the 11 patients showed myelofibrosis, in some cases before identification of the second genetic alteration. Our data, reflecting the largest reported study comprehensively detailing clinicopathologic features and response to therapy, show that the co-occurrence of BCR-ABL1 and JAK2 V617F is rare, with an estimated frequency of 0.4%, and most often reflects two distinct ('composite') myeloproliferative neoplasms. Although uncommon, it is important to be aware of this potentially confounding genetic combination, lest these features be misinterpreted to reflect resistance to therapy or disease progression, considerations that could lead to inappropriate management.
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12
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Chen Z, Wang W, Verstovsek S, Cortes JE, Medeiros LJ, Hu S. Chronic myelogenous leukemia in patients with MPL or JAK2 mutation-positive myeloproliferative neoplasm. Int J Lab Hematol 2015; 37:e150-2. [PMID: 26086872 DOI: 10.1111/ijlh.12398] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Z Chen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Hematology, Hua-shan Hospital, Fudan University, Shanghai, China
| | - W Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Verstovsek
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J E Cortes
- Departments of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L J Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - S Hu
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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13
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Qin YW, Yang YN, Li S, Wang C. Coexistence of JAK2V617F Mutation and BCR-ABL Translocation in a Pregnant Woman with Essential Thrombocythemia. Indian J Hematol Blood Transfus 2014; 30:331-4. [PMID: 25332611 DOI: 10.1007/s12288-014-0385-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 03/30/2014] [Indexed: 02/05/2023] Open
Abstract
In 2012, a 25-years-old pregnant woman presented with thromocytosis for 4 months, blood counts showed platelets 701 × 10(9)/L. Bone marrow examination disclosed a feature of hypercellular marrow in erythrocytic,granulocytic and megakaryocytic series. Cytogenetic analysis showed t(9;22)(q34;q11) in 100 % of metaphase. The percentage of BCR-ABL-positive FISH signals was 37 % in the peripheral blood. Molecular analysis showed the presence of the JAK2V617F mutation and BCR-ABL mRNA b3a2 transcript. A diagnosis of concomitant presence of essential thrombocythemia and chronic myelocytic leukemia was made. Based on this case and literatures reported before, it might be necessary to detect JAK2-V617F mutation and BCR-ABL fusion gene concomitantly in myeloproliferative neoplasms patients.
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Affiliation(s)
- You-Wen Qin
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Yi-Ning Yang
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Su Li
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
| | - Chun Wang
- Department of Hematology, Shanghai First People's Hospital, Medical College, Shanghai JiaoTong University, Shanghai, People's Republic of China
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Hussein K, Büsche G, Schlue J, Lehmann U, Kreipe H. [Myeloproliferative neoplasms: histopathological and molecular pathological diagnosis]. DER PATHOLOGE 2013; 33:508-17. [PMID: 23085694 DOI: 10.1007/s00292-012-1651-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Myeloproliferative neoplasms (chronic myeloproliferative disorders according to former nomenclature) comprise chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, primary myelofibrosis, chronic eosinophilic leukemia, chronic neutrophilic leukemia and systemic mastocytosis. All disorders have excessive proliferation of one or more hematopoietic lineages in common and progress with different probability to blast crisis or fibrosis. A further common feature is provided by the activating mutation of tyrosin kinases and associated pathways of signal transduction (BCR-ABL, JAK2(V617F), MPL(W515L/K), KIT(D816V) and FIP1L1-PDGFRA) causative for the abnormal proliferation. With regard to diagnosis and therapy these mutations are of utmost importance because they enable the exclusion of reactive processes, contribute with varying specificity to subtyping of MPN and are at least partly sensitive to targeted therapy. The molecular mechanisms of blastic and fibrotic progression are not yet understood.
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Affiliation(s)
- K Hussein
- Institut für Pathologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str 1, 30625 Hannover, Deutschland
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15
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Park SH, Chi HS, Cho YU, Jang S, Park CJ, Kim DY, Lee JH, Lee KH. Two cases of myeloproliferative neoplasm with a concurrent JAK2 (V617F) mutation and BCR/ABL translocation without chronic myelogenous leukemia phenotype acquisition during hydroxyurea treatment. Ann Lab Med 2013; 33:229-32. [PMID: 23667855 PMCID: PMC3646203 DOI: 10.3343/alm.2013.33.3.229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 01/11/2013] [Accepted: 02/26/2013] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sang Hyuk Park
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Hyun-Sook Chi
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Young-Uk Cho
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Seongsoo Jang
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Chan-Jeoung Park
- Department of Laboratory Medicine, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Dae-Young Kim
- Department of Internal Medicine, Division of Hematology, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Je-Hwan Lee
- Department of Internal Medicine, Division of Hematology, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
| | - Kyoo-Hyung Lee
- Department of Internal Medicine, Division of Hematology, University of Ulsan, College of Medicine and Asan Medical Center, Seoul, Korea
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Shimanovsky A, Bauer F, Silver J, Lamana S, Dasanu CA. A case of polycythemia rubra vera transforming into chronic phase JAK2 V617F mutation-negative Philadelphia chromosome-positive chronic myelogenous leukemia. Leuk Lymphoma 2013; 54:1567-8. [PMID: 23369042 DOI: 10.3109/10428194.2013.769217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Concomitant BCR-ABL1 translocation and JAK2(V617F) mutation in three patients with myeloproliferative neoplasms. ACTA ACUST UNITED AC 2012; 21:176-83. [PMID: 22847163 DOI: 10.1097/pdm.0b013e318246975e] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic myeloproliferative neoplasms (MPN) are clonal disorders of hematopoietic stem cells, which fall into distinct categories based on a number of characteristics including the presence of the BCR-ABL1 gene fusion (chronic myelogenous leukemia) or the JAK2(V617F) mutation (polycythemia vera, primary myelofibrosis, and essential thrombocythemia). One of the criteria in the 2008 World Health Organization Classification divides MPN into different categories based on the presence of an underlying genetic abnormality, however the WHO does not currently address the classification of myeloproliferative neoplasms that have more than one genetic abnormality. The coexistence of a JAK2(V617F) mutation and BCR-ABL1 is rare, and to our knowledge, less than 25 cases have been reported in the literature. Our case series examines the clinical, histopathologic, and genetic features of 3 patients with myeloproliferative neoplasms characterized by concomitant BCR-ABL1 and JAK2(V617F). The implications for diagnosis and treatment of patients with concomitant BCR-ABL1 and JAK2(V617F) are discussed as well as how the BCR-ABL1 and JAK2(V617F)-positive clones may be related to one another.
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Kreipe H, Hussein K, Göhring G, Schlegelberger B. Progression of myeloproliferative neoplasms to myelofibrosis and acute leukaemia. J Hematop 2011. [DOI: 10.1007/s12308-011-0096-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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19
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Toogeh G, Ferdowsi S, Naadali F, Alimoghaddam K, Ghavamzadeh A, Shirkoohi R, Ghaffari SH. Concomitant presence of JAK2 V617F mutation and BCR-ABL translocation in a pregnant woman with polycythemia vera. Med Oncol 2010; 28:1555-8. [PMID: 20499211 DOI: 10.1007/s12032-010-9570-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 05/10/2010] [Indexed: 01/09/2023]
Abstract
In 2007, a 27-year-old woman presented with mild splenomegaly. Blood counts showed hemoglobin (Hb): 17.8 g/dl, HCT: 56% and Red blood cells: 6.45×10(12)/L. Bone marrow examination disclosed a hypercellular marrow. Molecular analysis showed the presence of the JAK2 V617F mutation and BCR-ABL/BCR mRNA b3a2 transcript. A diagnosis of BCR-ABL-positive polycythemia vera (PV) was made. In 2009, she had nulipar pregnancy and treated with interferon-alpha. She delivered a healthy girl infant at 37 weeks. This case report suggests that in a PV pregnant woman with a concomitant presence of JAK2 V617F mutation and BCR-ABL translocation, the administration of interferon during the pregnancy could lead to a safe pregnancy and delivery.
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Affiliation(s)
- Gholamreza Toogeh
- Hematology-Oncology and BMT Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Pingali SRK, Mathiason MA, Lovrich SD, Go RS. Emergence of chronic myelogenous leukemia from a background of myeloproliferative disorder: JAK2V617F as a potential risk factor for BCR-ABL translocation. ACTA ACUST UNITED AC 2010; 9:E25-9. [PMID: 19858050 DOI: 10.3816/clm.2009.n.080] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the emergence of chronic myelogenous leukemia (CML) in a patient with JAK2V617F-positive polycythemia vera after 15 years of phlebotomy. The polycythemia vera clinical and molecular findings were suppressed at the time of CML diagnosis, only to re-emerge after the leukemia was successfully treated with imatinib. We explored the potential association between myeloproliferative disorders and CML in the context of the current literature and found a higher-than-expected coincidence based on known epidemiologic data for each specific condition. We hypothesize that myeloproliferative disorder (JAK2V617F or molecular events that cause JAK2V617F) is a risk factor for CML (BCR-ABL translocation). Because of therapeutic implications, clinicians should be aware that the conditions co-occur more frequently than once thought.
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Affiliation(s)
- Sai Ravi Kiran Pingali
- Department of Medical Education, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin, USA
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21
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Emergence of chronic myelogenous leukemia during treatment for essential thrombocythemia. Int J Hematol 2010; 91:516-21. [PMID: 20146031 DOI: 10.1007/s12185-010-0502-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 12/26/2009] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
Abstract
A 72-year-old male patient was initially diagnosed with essential thrombocythemia (ET), a Philadelphia chromosome-negative (Ph1(-)) chronic myeloproliferative disorder (CMPD), and was treated with hydroxyurea (HU). After 9 years of diagnosis of ET, his peripheral leukocytes gradually increased, while his platelet count showed a decrease. Bone marrow analysis disclosed Ph-positive chronic myelogenous leukemia (CML) in the chronic phase. Administration of imatinib mesylate (IM), a Bcr-Abl tyrosine kinase inhibitor (TKI), induced complete hematologic response in a month, but was discontinued after 4 months because of Grade 3 pleural effusion (PE). The treatment was switched to nilotinib which successfully induced a complete cytogenetic response (CCyR) after 5 months of TKI therapy and resolved the PE. Despite CCyR, however, ET recurred. Since then, the patient has been treated for 8 months with a combination of nilotinib and HU which has successfully controlled both CML and ET. This report includes a review of the characteristics of 15 reported cases with co-occurrence of CML and Bcr-Abl-negative CMPDs, including ours. Although rare, care needs to be taken since, despite the often similar clinical features of the two diseases, they require completely different treatments.
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A thrombocytosis occurring in Philadelphia positive CML in molecular response to imatinib can reveal an underlying JAK2(V617F) myeloproliferative neoplasm. Leuk Res 2009; 34:e94-6. [PMID: 19833389 DOI: 10.1016/j.leukres.2009.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 09/15/2009] [Accepted: 09/17/2009] [Indexed: 01/31/2023]
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23
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Reddy KS, Schwartz GE, Jamedhor M. A fertile XY/XX chimeric male with chronic myeloid leukemia in a minor 46,XX cell line and a history of polycythemia vera and trisomy 9 in the major 46,XY cell line. Leuk Lymphoma 2009; 50:1375-80. [PMID: 19562617 DOI: 10.1080/10428190903047761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Laibe S, Tadrist Z, Arnoulet C, Sainty D, Mozziconacci MJ. A myeloproliferative disorder may hide another one. Leuk Res 2009; 33:1133-6. [PMID: 19250672 DOI: 10.1016/j.leukres.2009.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 01/28/2009] [Accepted: 01/28/2009] [Indexed: 11/26/2022]
Abstract
Chronic myeloproliferative disorders (MPDs) are divided into Philadelphia-positive chronic myeloid leukemia (CML) and Philadelphia-negative disorders including polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis (IMF). Concomitance of a CML and another MPD is a rare event. We report here the case of a patient presenting initially with IMF who developed a Philadelphia-positive CML 7 years later. At the time of CML diagnosis, two distinct clones were present, one with a 13q deletion and one with a t(9;22). We raise the problem of a CML developing on an initial IMF, or two MPDs occurring from a common or two different stem cells.
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Affiliation(s)
- Sophy Laibe
- Département de Biopathologie, Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille Marseille, France
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Jallades L, Hayette S, Tigaud I, Johnston A, Coiffier B, Magaud JP, Ffrench M. Emergence of therapy-unrelated CML on a background of BCR-ABL-negative JAK2V617F-positive chronic idiopathic myelofibrosis. Leuk Res 2008; 32:1608-10. [PMID: 18448166 DOI: 10.1016/j.leukres.2008.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 03/03/2008] [Accepted: 03/04/2008] [Indexed: 11/16/2022]
Abstract
We report the emergence of a chronic myeloid leukaemia (CML) during the course of a JAK2V617F-positive chronic idiopathic myelofibrosis (CIMF) in the absence of any myelosuppressive treatment. Although a response to imatinib was observed, the underlying myelofibrosis persisted after treatment and hydroxyurea was finally added to control the persistent thrombocytosis. Such rare patients with co-existing BCR-ABL translocation and JAK2V617F mutation must be identified in view of the possibility of targeted therapies. Moreover, the detection of BCR-ABL translocation appears to be crucial especially in the case of treated CIMF with an atypical course to identify CML before acute transformation.
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Affiliation(s)
- Laurent Jallades
- Laboratoire d'Hématologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
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